Coffee Bible and Prayer

Look at the proud!
  They trust in theirselves, and their lives are crooked.
But the righteous will live by their.
   faithfulness to God.

Wealth is treacherous,
  And the arrogant are never at rest.
They open their mouths as wide as the grave,
  And like death, they are never satisfied.
In their greed they have gathered up many nations
  And swallowed many peoples.
- Habakkuk 2:4-5

Pride and greed are killers that sneak into the unexpected areas of our lives. So insidious are their ways, we are often caught defending that which is separating us from God.

MS wk 5 Journal

MS wk 5 Journal—Williams

This past Friday was a unique day at the hospital. The overall census at the hospital was down due to the holidays therefore they were consolidating patients in order to shut down a portion of the hospital to save money. 7A, the stroke, neuro unit was the unit to go dark until needed again. The last mother of the last family that I lived with worked as a nurse at a very small hospital (25 bed) up in Northern California. She was a night shift nurse and it was common during different times of the years for her to be called and either placed on call, or given the whole night off. The fluctuations in census made sense to me due to the small tourism town, however I didn’t really expect to see it at such a large hospital.

The day provided us with a unique opportunity to see multiple discharges and transfers. I was able listen in on the phone conversations from one nurse to another that had to be done prior to the new unit receiving the patient. I was also able to see some of the difficulties that come with either transfer or discharge. The patient, the nurse, and the family could be ready to leave, however they could be stuck waiting on the doctor to enter the discharge orders into the computer. Or perhaps the orders for transfer to a new unit have been made, the patient is ready, yet the nurse assume that they are waiting on a call from the new unit before the patient moves, when in fact the new room is open, and they are waiting to hear from the nurse with the patient. I believe that double-checking, and making reminder calls is better than doing nothing, even at the risk of getting on someone’s nerves. If problems can be avoided simply by better communication then it is worth taking a bit more time to clarify instruction, or lack thereof.

I believe that I had written one of the previous weeks regarding the potential for medication errors, and this week I had the opportunity to see the effects of one first hand. The order for TPN was not re-entered by the doctor, and neither the pharmacy nor the night shift nurse caught the mistake, or questioned why a new bag was not going to be sent up. Through this mistake the patient was without food for a period of time, somehow placed on a mechanical soft diet, and then placed back on the TPN without an alteration to the PO diet. It was interesting to watch the circle of blame, go from the nurses blaming the doctor, then blaming the pharmacy when the doctor was in the room, and the doctor blaming both the nurses and the pharmacy. I can see how it was perhaps the initial fault of the doctor for not reordering the medication, however the checks and balances in place (nurses and pharmacy) failed to catch the mistake, and the error was carried out to the patient’s detriment. Fortunately it was not a mistake of a greater magnitude.

I was a little frustrated with the seriousness with which the nurses were taking my concerns. I originally pointed out the rise of WBC from 14 to 26.9 in a period of two days while in the presence of antibiotics, which were discontinued that day. I understand now that the rise in WBC is not likely due to an acute infection, however neither nurse one, or nurse 2 could give me a straight answer for the WBC increase or the d/c of the antibiotics. Perhaps they were playing devils advocate, and making me think critically about it, but I don’t think so. I understand that I am very very new at nursing, so perhaps a level of 26.9 when the range roughly 4-10 is not that bad, but some indication as to why would have been helpful.

I also found that my concern over the growing abdominal ascites was not taken seriously. I mentioned it more than once, and the greatest response I received was, “Go get me a set of vitals, and we’ll see what that tells us.” The vitals were within the patient’s normal, however that does not change the fact that the pt stomach had gown much larger in the course of the day. I wish I had measured the pt’s abdomen somehow so that I could have given some concrete evidence. The best evidence that I had was that his respiration rate had bumped up 5 breath/min since the morning, even though he had received a narcotic for pain that afternoon which may cause slight respiratory depression. I had the opportunity to see a paracentisis while doing pt contact hours when I was getting my EMT license, and I watched 3L of fluid get pulled out of an alcoholic’s abdomen. Every person is different, yet his abdomen was not as large as the pt on Friday. I don’t know what more to say about this, in my opinion his stomach had doubled its volume in the course of 8hrs.

            The last thing that is related to assessments was the level of thoroughness that I have seen with physical assessments on the unit. I was impressed to see that the new nurse, nurse one did things like asses grip strength, muscle ROM and strength, took the socks off to find pedal pulses, and inspect the feet, as well as listen to the heart in two different places, and correlate that with a radial pulse. It was the most in-depth assessment that I have seen by a nurse in the hospital yet. However as I did my own assessment alongside him, I noticed that he did not mention an irregular heartbeat. The admission history as well as the patient hand off sheet said that the patient had normal S₁ and S₂ sounds with a normal rate and rhythm, however the patients heart rhythm was clearly not regular. I went back and checked three times over the next 30min to make sure I was not making things up, I would check apical pulse along with a different peripheral pulses at the same time. It was likely nothing more than A-fib, which is fairly common, and frequently presents with no symptoms or adverse effects for the patient, however a-fib is correlated quite strongly with cerebral ischemic events. (5 times more likely according to AHA, and National Stroke Association). Maybe it is of no big concern at the end of the day, however I think it is of greater concern that two individuals got two different results. If it was a scientific study both sets of data would be tossed until consistent, and independent results could be presented. Here again I probably should have said something but it is difficult to come up with the courage to contradict both the previous paper work as well as another more experienced nurse’s assessment.

One of my biggest struggles right now regarding clinicals is not knowing the level at which I should be involved. This past Friday I sought to function slightly more like a nurse on the unit. I organized a blank paper in the same manner that one of the other nurses did in order to keep track of 4 patients at once. I would take notes at each beside report in the morning, and I attended the 9am meeting with the case manager, other nurses, PT, and the doctor. I sought to fill my role as a student and understand the role of a floor nurse with multiple patients. I think I may have gotten in the way a little bit.

I honestly think I did a fairly good job this last Friday, I don’t think that I would change much, except for perhaps taking to the clincal instructor regarding conflicting assessments, or patient concerns that I feel are not being appropriately addressed.

Four pears: $1 My baking: Priceless

I really love food, I enjoy the process of making it just as much as eating it.

Friday was the end of a semi stressful week, which included our first lab competency test, our first test in Health Assessment, and our first test in Pharmacology. I say semi stressful because when looking at next month we have seven tests, more lab competency, and since clinicals start this Friday, every Friday for the next 15 months will probably be booked from 5am till 7pm. That will be a bit more stressful.

Friday evening arrived and I really didn’t feel like studying, so I baked. I had recently bought 4 pears for a dollar at a local store (there were about 12hrs from being rotten), I decided these would worked well in a baked good. Even if there was some nasty bacteria or mold in the mushy parts, cooking them in the oven at temps between 425 and 350 is well over the temperature at which surgical equipment is autoclaved at. (121 C for 20min)

I started by trimming off the really nasty parts of the pears, and then diced all four up into irregular shapes. I had quite the pile of pears, so much so that I figured that I could probably do two different things with them. I decided to bake both muffins as well as some loafs of bread.

Unfortunately I have yet to acquire proper baking tins, bowls, pans.. therefore the muffins were mixed in a stove pot, and then cooked in the only muffin tins I had. Tiny ones.They turned out really well despite their small stature. The muffins contained the typical ingredients of butter, eggs, sugar, flour, soda, powder, and milk, but what really made them tasty was cup of diced pear, 1/2 tsp of cinnamon, and ¼ tsp of nutmeg.

They were easy and fun to make. Since they were so small it only took 12min to bake them, and since they are so small I can eat ten of them in one sitting and not feel bad about it. It is like eating ice cream with a small spoon. Always better.

The second tasty treat was indeed tasty. Baking loafs is slightly more complicated than muffins, and I wanted to change things up a bit.

Again for want of a proper mixing bowl I mixed the dry ingredients in a stovetop pot. Once the typically dry ingredients had been mixed together I decided to add a few handfuls of dried cranberries, and followed that up with a few handfuls of chopped walnuts. I mixed in the wet ingredients and placed it all into the pans available to me, a loaf pan, and a cake pan.

The bread turned out great. I wish you could have some. The dried cranberries give it a sweet tang, which is only accented by the unmistakable flavor of walnuts all the while surrounded by the taste of almost overripe organic pears. Not too light, not too dense, one of my best works. It is delicious.

Just a Quick Note

For the past few days I have been a bit down because of a number of little annoying things keep popping up. Some were as ridiculous as me being irritated that it was another 90-degree day with 90% humidity, others were a bit more legitimate such as the uniform store not having my order ready despite a phone call assenting that they did. I have been irritated that my knees wont leave me be, that my teachers are disorganized, that I have no money, and that I don’t really like homework.

But I have realized that in the same way I no longer get stressed for tests, there is no reason for me to get frustrated at much of what is currently going on in my life. It is about a 50/50 mix of things I can have an effect on, the stuff I don’t like, and those that I cannot change. However I can do something for each one of those categories.

I need to focus on what I can take care of, and do that well. I need to let go emotionally of what I cannot change, and then change my perspective regarding what I don’t like. Granted most of this relates to school, however sometimes it is easier for me to think of it in terms of running.

I cannot change the way that God made my body. I cannot change the years of physical abuse I took it through. I would like to be able to wake up each morning and run free and easy. I would like to knock out a 100 mile week like it was nothing. That just isn’t going to happen. I don’t like drills, stretching, and doing the little things. But if I can change my perspective, accepting who I am, and where I am, and begin to embrace what I have historically disliked, then undoubtedly I will see some changes.

Sometimes the big things matter, but more often it is the little things that will make the most authentic, and lasting changes in our lives.

Despite the histrionics that most days consist of, life can be quite simple if we choose to live that way.

PS: today is the most beautiful day in Virginia so far. It 74 and only 46% humidity. All 14 windows and the balcony door are wide open.

Living LARGE! Just kidding

A little about life here in Virginia, first thing to note is that it is much more humid than I am used to. I went on a run yesterday around 7am found myself drenched with sweat. I could ring out copious amounts of fluid that had been produced by my seemingly overactive sudoriferous glands. I took a quick shower before breakfast, and dried off only to find that I was still wet. It was strange.

 This is a picture of what I typically live off of; the only thing missing is some type of nut butter, tortillas, spinach, honey, wheat bread, and bananas. This is not all I eat, but I would call it my staple.

Today I went to the farmers market and bought two zucchini, two sweet potatoes, one bell pepper, and I also managed to get 12 white peaches for 2 bucks. (not everything for 2 dollars just the peaches). Lauran, her friend Laura, and I grilled up the veggies and a few hot dogs out on the patio. It was a great way to spend the afternoon. Tasted good too.

I like to travel light. Every time I have to pack up and move to a new place I am amazed and slightly disgusted at the amount of stuff I have accumulated. Therefore each time I try to condense what is necessary, and do away with what is not. Here is my room. 

My fine bed

my lovely desk

my clothes 

Nursing School and Ashburn Virginia

The past few days have been rather hectic, and classes haven’t even begun.

For the past four days we have been bombarded by welcome speeches from the Dean, from the associate Dean, the Director… and many more. I found out that there were over 270 individuals that applied for the program, and only 51 were accepted. I am one of 7 guys.

This semester I will be taking Transition: Nursing Profession, Health Assessment: Foundations, Med Surg I, Med Surg I-lab,  and Pharmacology for a total of 20 units. And somewhere in there will be a weekly 12 hour clinical in a hospital or clinic.

The two ladies that I am living with are also in the program. One of them has just finished up their first degree at Cornell, while the other has been out for a year longer than me. Our apartment is incredible… and incredibly expensive too. I chose to room with individuals that were also in the program rather than out on my own believing that it would facilitate my pursuit of this nursing degree to a greater extent. Although I am sure I could have found some cheep dump to live in, I am now living in a 1436 sq ft three bedroom two bathroom mansion for $1,875 a month.

Money is hard to come by, especially when one has not held a steady job. Sometimes I long for the sense of security that a consistent income would provide. However there is a constant danger of feeling self-sufficient. I don’t want to forget that God has brought me to where I am now, and God will take me through what is ahead. By attaining an all encompassing scholarship, and an ensuing high paying job it would be easy to loss my dependence on God. Living day do day wondering how to come up with $40,000 for this year keeps me trusting that the God that has been with me thus far will continue to be with me.

Since in the past it seems as though my life has been nothing but school and running, it would be wrong to not write a bit about running here.

I have always believed that I can to almost anything that I set my mind to. I think this is what has contributed to my injuries as well. I will wake up, shoot for the stars, and run like there is no tomorrow… and likely there is no tomorrow as far as running is concerned since I destroyed myself the previous day.

I still believe that I have a good bit of running left in me. All I need is to find the resolve to be committed… and see it through to the end.

West Virginia and the New River Gorge National Park

West Virginia is a very beautiful state, although there might be just as many tobacco fields as corn fields now, it is green and hilly once again. West Virginia is one of the United States top coal produces, second only to Wyoming. This was evident by the many ‘I heart Coal’ bummer stickers that I saw.

In the 1870’s over sixty mining towns developed on the New River Gorge. Much of this coal helped full the United States for over half a century during the industrial revolution. Now they are almost all abandoned ghost towns, remnants of the past fading into the foliage.

band of coal in NRG

The Allegheny Mountains that the New River Gorge is located in are deceptively larger than they seem. This is the case for the Appalachian and Blue Ridge Mountains as well. I was impressed with hidden cliffs and rough landscape beneath the green canopy of trees.

The New River Gorge is not really appropriately named. It should be called the oldest river ever. It winding path is evidence of its millions of years cutting through the Appalachians, one of, if not the oldest mountain range in the continental US.

Some of the cliffs that we hiked around were easily over one hundred feet tall and yet they were completely hidden. The maze of magnolia trees wove their roots over our path and hung their vibrant leafs only just above our heads. Various vines climbed the rock, white oak, and Virginia pine trees. The visual beauty along with inescapable song of the cicadas’ made our hour hike along the rim of the New River Gorge a wonderful stop.